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The Business of Hospital Libraries

Earlier last week people on medlib-l discussed (The perfect library storm) closures of hospital libraries. They are seeing a contradiction between Evidenced Based Medicine imperatives vs budget and resource demands on hospital libraries. Some are seeing how the increase in pricing and bundling practices have caused the hospitals to “throw it back to the physicians and staff” causing libraries to close. I interpret this statement to be that the hospitals are no longer willing to provide monies for institutional support of resources (the library) and require doctors and staff to buy their own resources.

Personally, we hospital librarians need to start treating our library like a hospital department and not a library. I mentioned this in my medlib-l post. I know this statment sounds odd because you might think we do that already. I think we could do better. I think librarians not only need to align their goals to the hospitals, but they need to make the hospital’s goals their goals.

With the Affordable Care Act, hospitals stand to lose 1% of their Medicare payments in penalties if patients with specific conditions are readmitted within 1 month of discharge. By 2015 it will be 3%. That is billions of dollars. To put it in perspective, Barnes-Jewish Hospital in St. Louis will lose $2 million dollars according to Kaiser Health News. Dr. John Lynch the chief medical officer of Barnes-Jewish says they could absorb the loss this year but not over time if penalties continue to accumulate.

You better believe all of the other hospital departments in your hospital are working toward the hospital goals. Aligning the library to demonstrate specifically (hard numbers) how it can help the hospital achieve their goals is essential.

I thought long and hard about my post to medlib-l before I sent it. The reason was I didn’t want to lay blame for hospital libraries closing on the librarians. I didn’t want to imply that they weren’t doing their jobs or that if they “could’a, would’a, should’a” they would still have their jobs. That wasn’t my intent. Although, one person responded on the list saying they found it “disheartening that sometimes when a library staff is downsized or actually closed, that a too common belief is that if only ‘that library’ had been doing more, building a stronger case, demonstrating their worth in concrete ways, etc., etc., this would not have happened.”

Who knows what the situations were at those hospital library closures or downsizings? However, I firmly believe if you don’t start looking at your library as a business arm of the hospital and align your goals to support the hospital achieve its goals, then you are going to have a very rough time. Because if an institution as established and good as Barnes-Jewish is dealing with these things, then it can, and is happening everywhere. Where do you think the library stands when the institution has to deal with a $2 million dollar loss one year? Repeatedly? Where do you think it stands if you do not illustrate exactly with hard numbers how your department has helped prevent that loss.

I think everyone (administrators, doctors, nurses, etc.) can agree that the idea of a library is good. But when faced with money demands, that idea needs concrete specific support. That support must be generated from within. Administration doesn’t care about the library in terms of JCAHO standards. Administration doesn’t care about the Rochester study or newer updated similar published research. Administration cares about what your library is doing now. Those studies, standards, etc. aren’t going to change your administration’s mind, you are. They don’t care if you give them every flipping article under God’s green earth saying that a library will save them money and help them cure every disease known to man. Administration only cares about you, your library, what you are doing, and how it benefits them.

I am not alone in thinking that hospital librarians need to change they way they think and do “library business.” The Mid Atlantic Region will be running a CE webinar series starting May 31, 2013, entitled “Running Your Hospital Like a Business.” Some of the things the series will address are: writing a business plan, art of negotiation, and proving your worth/adding to your value. All of these things are those business skills that I ran away from in college but now am kicking myself as I realize I really need them today and could’a, should’a taken a business class back then.

7 thoughts on “The Business of Hospital Libraries”

“Although, one person responded on the list saying they found it “disheartening that sometimes when a library staff is downsized or actually closed, that a too common belief is that if only ‘that library’ had been doing more, building a stronger case, demonstrating their worth in concrete ways, etc., etc., this would not have happened.”

Who knows what the situations were at those hospital library closures or downsizings? However, I firmly believe if you don’t start looking at your library as a business arm of the hospital and align your goals to support the hospital achieve its goals, then you are going to have a very rough time.”

I’m so glad to see you writing about this crucial topic – thank you!

It’s my impression that elements of the perfect storm have not been completely identified. There are more squalls off the bow and aft…

Of course I agree that the hospital library should be approached as a business arm of the hospital.

However, many hospital librarians are solo; they do not have sufficient skills, support, or mentorship to follow this recommendation.

Frequently, hospital librarians feel themselves adrift without support. To ask our colleagues to take action when they have no other staff but themselves, for example, is unrealistic.

Some of the hospital librarians I interviewed for my dissertation research (motivated by my own experience and observations as a hospital librarian, and by the Vital Pathways symposium) were subjected to the following:

– taking on roles for which they were untrained and unsupported (such as managing the hospital intranet) just to keep the library viable – and having to set aside library work to do so;

– running hospital libraries on a ZERO budget, but still working like mad to convince administrators of the need to support patient care by keeping the library alive;

– demoralized by a lack of support, using ‘back roads’ ways just to get access to software needed for basic operations… and more.

Librarians were sometimes, furthermore, hesitant to reach out through Medlib-L or to colleagues at academic medical centers, for a variety of reasons.

I responded just now to the discussion, saying that MLA itself needs to step up the game here. We may have some cultural issues (silos of operation, for example) that contribute to the situation, or at least do not help to alleviate some of the problems mentioned.

Further, I’d like to ask – what can we do to help our colleagues replicate the Values study in their own settings? While there are CEs available to assist librarians to acquire skills in more businesslike library management, is this working for hospital librarians during this transitional era? Here is an opportunity (a multitude of them!) for collaboration.

Michelle, one more thought after re-reading your Medlib-l post. You said

“Obviously I simplified the example a bit and there would be a lot of
people to work with. But my point is, do we need to start doing our own
mini research studies to clearly show our OWN library’s impact on our
OWN institution. It is nice to show the Marshal studies and other ones,
but administration wants to know what we are doing in more concrete
terms not what somebody else is doing as proof of our worth.”

The Research Section is just embarking on a series of systematic reviews using teams of interested librarians. Why could we not do the same, organized by people in the HLS, to do “mini-Marshall’ replications?

I think it has to be simple. Many hospital librarians are solo and have never done research. Something like a plug and play research example where it walks them through exactly how to do it themselves.
I think this would be very helpful. MLA an other organizations can advocate for standards until they are blue in the face but society in general has changed. It is what have you done for me now society and we need to show our admins exactly what we do for them. Admins and JCAHO and other don’t care about library advocacy. It falls on deaf ears. Instead of waiting around for them to get their hearing back I think we hospital librarians need to take matters into our own local hands.
Hospital librarians have done that but the game has changed and we need to change the way we play it. We just need the new tools to do it.

No problem! I’m impressed that you typed that much text on your phone (mine would have many more errors, believe me). After I’d signed off I also had the thought, Michelle, that regardless of what happens to hospital libraries, hospital librarians are a valuable resource.

While doing my dissertation research I kept thinking… here are these wonderful, passionate, caring people ‘without a net’ – and we ***cannot*** fail to support them. If many end up in academic or other libraries as a best-case outcome of library closure – having collaborative research experience can only enhance employability and networking.

MLA and other LS association standards are prescriptive, not descriptive. The HLS work has been really important, providing data of interest to many in an area where there is far, far too little data to be had.

Sorry if this response is scattered – the situation and people are so much on my mind. I know the librarian who announced her library’s closing as a young, bright, future leader in our profession. I think we have a responsibility.